If you choose to have reconstruction with breast implants after mastectomy, your plastic surgeon will choose the implants that best fit the dimensions of your chest, while providing the volume and shape you prefer.
Reconstruction with breast implants is the most common method of recreating breasts after mastectomy. A variety of FDA-approved breast implants are available, with different sizes, shapes, projection and fillings. It's important to discuss the advantages and disadvantages of these different features with your plastic surgeon before your reconstructive procedure.
Shape
Breast implants are either round or contoured (teardrop or anatomically shaped). Round implants create more cleavage and fullness above the nipple. Contoured implants are shaped more like a natural breast; they're longer and more slender at the top with more fullness at the bottom. Compared to round breast implants, contoured breast implants are more firm and better maintain their shape and position. Contoured implants have a roughened, textured surface, which is designed to adhere to the scar tissue that naturally develops around the implant. This increases the likelihood of the implant staying in place without shifting, rotating or distorting the breast shape. (Round breast implants may also be textured or smooth, allowing them to move under the skin or muscle, much like natural breast tissue.) Texturing also reduces the chance of capsular contracture, which is hardening of the scar tissue.
Breast implants are either round (top) or contoured (bottom).
© 2023 The Complete Guide to Breast Reconstruction, Johns Hopkins University Press
Size and Projection
Ranging from small (100 cc) to large (800cc) and in between, breast implants are available in many different sizes. However, choosing the ideal size is a bit more complex than selecting a bra because breast implant volume is measured in cubic centimeters (cc) rather than cup size. Although breast implants used in the United States range between 100 cc and 800 cc, the dimensions of your chest most influences which implants will provide the fullness and projection you want in your new breasts.
Before your surgery, your plastic surgeon will take careful measurements--from nipple to nipple and the base width (from the inner cleavage to the outer edge of each breast )--to determine which breast implants will be the best fit for you. The goal is to select implants that are the same as your chest width or slightly more narrow. If your chest is 12 cm wide, for example, a breast implant with that measurement or slightly more narrow is the best choice. Implants that are too narrow or too wide can cause cosmetic issues which may then require additional surgery to remove or replace the implants. Breast implants that are too small won't give you the volume you want, while implants that are too large may upset the aesthetic proportions of your body.
The projection of a breast implant is an additional consideration to discuss with your plastic surgeon before your reconstructive procedure. Generally, a narrow chest requires a higher profile implant to look natural and achieve the desired breast size. High-profile implants provide more projection; low-profile implants have less projection. If you have a large body frame, low- or moderate-profile implants, which are wider at the base, may be a better fit than high-profile implants.
Low-profile, moderate-profile and high-profile breast implants provide varying degrees of projection.
© 2023 The Complete Guide to Breast Reconstruction, Johns Hopkins University Press
Interior and Exterior
All breast implants used in the United States have an outer shell of medical-grade silicone filled with either sterile saline (salt water) or silicone gel.
On the Inside
Implants filled with cohesive silicone gel have a thick, semi-solid interior with a consistency like Jell-O. They create a breast that is relatively soft and feels similar to natural breast tissue. Highly cohesive silicone gel implants, often called "gummy bears," are said to be "form stable." Like gummy bear candies, they maintain their shape even if the shell is torn or cut. Silicone gel implants are prefilled by the manufacturer.
Saline breast implants are empty when placed in the chest, and then filled to the desired size by the plastic surgeon. They are essentially sacs of salt water. They lack the softness and bounce of silicone gel, which more closely mimics the feel of natural breast tissue.
On the Outside
Contoured breast implants have a rough, textured exterior that adheres to the scar tissue that naturally forms around the implant, so they're more likely to stay in position without shifting or rotating. Texturing is also intended to reduce the likelihood of capsular contracture, which occurs when the scar tissue around the implant hardens and may cause pain and/or distort the shape of the implant. Round breast implants may be textured or have a smooth exterior that allows them to move under the skin or muscle, much like a natural breast does. Textured breast implants are linked to a slightly increased risk of breast implant-associated anaplastic large cell lymphoma, a rare cancer of the immune system.
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